Appliance for facilitated X-ray examinations of ankle injuries



E. D. SEDLIN APPLIANCE FOR FACILITATED X-RAY EXAMINATIONS OF ANKLEINJURIES Jan. 24, 1961 2 Sheets-Sheet 1 Filed Dec. 1, 1959 INVENTOR;Elias l7. .SeaZZzrz ATI'ORA/m Jan. 24, 1961 E. D. SEDL N 2,969,061

I APPLIANCE FOR FACILITATED X-RAY EXAMINATIONS OF ANKLE INJURIES FiledDec. 1, 1959 2 Sheets-Sheet 2 Fig.5.

INVENTOR. Elias D. SedZz'n w /wz APPLIANCE FOR FACILITATED X-RAY EXAMI-NATIONS OF ANKLE INJURIES Elias D. Sedlin, Bronx, N.Y., assignor to theUnited States of America as represented by the Secretary of the ArmyFiled Dec. 1, 1959, Ser. No. 856,622

2 Claims. (Cl. 128-84) (Granted under Title 35, US. Code (1952), sec.266) The invention described herein may be manufactured and used by orfor the Government for governmental purposes without the payment of anyroyalty thereon.

Injuries to the lower extremities of individuals engaging in outdoorsports and activities of highly diversified character, are so frequentin occurrence that special provisions are required at many locations fordiagnostic and treatment purposes. Thus, for example, military posts,wherein the primary mission is that of basic infantry training, arerequired to diagnose and to treat large numbers of both acute andchronic ankle injuries, andthe necessity therein for stress inversion oreversion roentgenography in the accurate diagnosis of chronic and acuteangle conditions has been cited numerous times.

The instant invention presents a device which in actual operationconstitutes a very material aid when stress inversion or eversion filmsof the ankle are needed. Prior to the present invention, stressinversion or eversion films have been obtained by use of the surgeonshand holding the foot in the desired position; and it has beenemphasized that prior to the instant invention, in diagnosis of lateraltear, the surgeon should position the ankle himself, wearing rubbergloves to protect his hands. However, in the development of the presentinvention, it has been noteworthy that the wearing of gloves, whichprovide sufiicient protection against irradiation, interferes with thesurgeons ability to grasp the heel of the injured foot and to maintainthe foot and ankle of the patient in proper position while films arebeing taken.

The wearing of gloves, moreover, obviously does not protect the surgeonfrom irradiation except for his hands, and the continued use of stressroentgenographyin examining large numbers of ankle injuries has aninherent hazard of excess exposure to irradiation for surgical andmedical personnel, especially where suchpersonnel are located on amilitary post where such injuries are of common and numerous occurrence.In addition, an unduly large amount of the surgeons time is taken up bythe gloved positioning and holding of the injured part.

Consequently, it has been desirable to design and to construct amechanical device or surgicalaccessory which would provide an adequatesubstitute for a surgeons hands for this type of work, and it isconsidered that, on the basis of experience gained from actual use, theappliance of the instant invention which will be described hereinafterfulfills all requirements and is, in some ways, superior to the use ofthe surgeons hands.

From the foregoing, it may be considered that the instant invention hasfor an object the provision of a surgical appliance or accessory for usein instances where there is present the necessity for stress inversionor eversion roentgenography in the accurate diagnosis of both acute andchronic ankle conditions, which accessory is applicable easily to theinjured member, and holds such member in proper position for the makingof either stress inversion or eversion roentgenograms. In practice,there are found only limited indications for stress eversionroentgenogra'rns, so that actual experience in the use of States PatentlCC the instant device has been predominantly with stress inversionroentgenograms and the description and discussion which follows isconcerned with the use of the appliance for stress inversion.

The accompanying drawings represent an exemplary, although a preferredembodiment of the device of the invention, in which drawings:

Fig. 1 is a perspective view of the accessory when in service;

Fig. 2 is a top plan view of the metallic foot-piece, the padding linerbeing omitted;

Fig. 3 is a transverse vertical sectional view, taken on the line 33 ofFig. 2, looking in direction of the arrows, the View, however, showingthe padding lining for the foot-piece in position;

Fig. 4 is a transverse sectional view taken on the line 4-4 of Fig. 2looking in the direction of the arrows;

Fig. 5 is a side elevation of the footpiece of the accessory; and

Fig. 6 is a bottom plan view of the accessory of the invention with thethigh strap attached thereto.

Referring more particularly to the drawings, the illustrated embodimentof the invention comprises a footpiece A composed of complementalelongated metallic plates or strips 8 and 10, which may be adjustedlaterally to fit snugly any adult foot, each strip 8, 10, having itsrear outer edge portions formed into corresponding upstanding heelflanges 12, 14, and the forward portions formed into forefoot flanges16, 18, the heel flanges 12 14 being adapted to engage snugly the heelof a patient, and the forefoot or frontal flanges 16, 18 being adaptedto engage snugly against the patients forefoot. The foot-piece A isdesigned to enable it to fit any adult foot and to be used to maintaininversion or eversion in combination with dorsiflexion, plantar flexion,or neutral positions of the foot, selectively.

' For accomplishing the desired position of the foot, an anchoring thighstrap B is provided, together with a flexible traction cable or rope C.The foot-piece A is composed of complemental elongated plates or strips8, 10, as aforesaid, these being made of a light metal, preferablyaluminum, and turret clamps 20, 22, are riveted as shown at similarlocations on the underside of the complemental plates 8, 10, at the heeland forefoot areas of these plates. Rivets 24 and 26 turnably secure theturret clamps to the plates of the foot-piece, the turret clamps beingsimilarly apertured for receiving movable connecting rods 28 and 36along which the foot plates 8 and 10 may be adjusted laterally tocorrespond to the Width of a patients foot with the heel and forefootflanges on the plates snugly engaging the foot on both sides thereof.Adjustment may be secured by tightening set screws 32, 34 against theconnecting rods 28, 30, the connecting rods 28 and 30 having holesthrough them adjacent to their ends for receiving eyelet rings 36, 38,which receive nope clamps 40, 42, through which is passed the tractionrope C, the thigh band B being provided similarly with a sewed-on strip44 for holding a loop 46 of the flexible traction rope or cable C. Eachof these clamps 40, 42, has an enlarged clip end 48 which receives aneyelet ring and a restricted clamping end 50' into which the tractionrope C is pulled and is compressively clamped and held tightly until itbecomes desirable to release the same.

The movable connecting rods 28, 3t), enable the accessory of the instantinvention to be applied to either foot for both inversion and eversionstress roentgenograms. As has been noted above herein, there are onlylimited indications for stress eversion roentgenograrns, so that theforegoing description and discussion as well as that which follows isconcerned with the use of the appliance for stress inversion.

Application of the appliance for stress inversion films is as follows:

With the patient supine, the anchor strap B is applied just above theknee, into the traction rope C placed medially. One or two turns ofelastic bandage 52 then are wrapped slightly above the ankle. Thefoot-piece A then is fitted so that it conforms snugly to the heel andforefoot of the patient; with the beginning of the heel flanges 12 and14 placed inferiorly to the malleoli, the elastic Wrapping is continued,as is indicated at 54, over the foot-piece A until the latter is firmlyattached to the foot, there having been glued or cemented layers of feltor equivalent padding 56 to the plates 8 and of the foot-piece, whichpadding layers are extended to include the heel flanges 12, 1 and theforefoot flanges 16 and 18 of the plates 3 and it? for inhibiting anylikelihood of slipping between the patients foot and foot-piece A. Theconnecting rods 23 and 30 then are passed medially as far as possibleand the plates of the foot-piece A again are squeezed against thepatients foot and the set screw clamps 32 and 34 of the connecting rodsare tightened. The hindfoot and forefoot of the patient now are movableas a unit. Maximum inversion and moderate plantar fiexion stress areapplied, and traction rope C is pulled through the tapered slots 5% onthe rope clamps and clamped in the restricted clamping ends 50 thereof,and the patients ankle is ready for an AP stress inversion film.

Reversal of the anchor strap B and the connecting rods 28 and 3tprepares the ankle for stress eversion films.

As further illustrating the method of fabrication of the device of theinstant invention, the following specific procedure may be noted asbeing a preferred procedure.

The foot-piece A is fashioned from 16-gauge sheet aluminum and is outfrom a pattern measuring substantially 11 /4 inches in length and 3%inches in width at the level of the heel flanges 12, 14, andsubstantially 3 /2 inches in width at the level of the forefoot flanges16, 18. The heel flange i2, 14, measures approximately four inches inlength and is gently curved posteriorly. The forefoot flange f6, 18, iscurved internally about one-third of its width. Each turret clamp 26,22, is machined from substantially one-inch round stock 24 ST aluminum,or an equivalent, and is drilled to retain a /8 or AGlHCh rod(connecting rods 28, Stl), and at right angles to this a small hole isdrilled and threaded to retain the clamping screws 32, 34, each of whichis A"-20 x /2", or as available. Each connecting rod 28, 30, is made ofor -inch cold rolled steel approximately six inches in length and isdrilled at either end for a retaining ring 36, 38, and rope clamp 41 42.Each rope clamp is bent from approximately -inch wire to hold thetraction rope C firmly where it is pulled into the tapered slot 58. Theretaining rings 36, 33, are formed from approximately /s-in-ch weldingrod. An anchor strap B is prepared from approximately 1%.- inch webstrapapproximately 18 inches long with a buckle 60 and a sewed-on strip towhich a traction rope C is attached so that each end of the tractionrope extends about 2 /2 feet from the loop 46. The footplate A now isdrilled anteriorly and posteriorly to receive turret clamps 2t 22, andeach section of the footpiece now is bent to a 90 angle in its long axisalong a point through the middle of the narrow center portion. Theturret clamps are placed in the previously drilled holes in thefoot-plate and riveted in place by rivets 24, 26, so that the turretclamps are free to rotate on the foot-piece and yet be firmly attached.The foot-plate A now is divided along the line of the 90 bend, thusforming the complemental plates 8, 1d. The crossbars 23, 30, now arefitted through the "holes in these turret clamps 20, 22, the two halvesof the foot-piece (the cornplemental plates 8, 1d) are brought togetherand the retaining rings 36, 38, carrying rope clamps 4t}, 42, are placedthrough the previously drilled holeson the cross bars 28, 30. A layer offelt or equivalent padding 56 is glued or equivalently secured to theinside of the complemental plates 8, 10, toeover the inside surface ofthese plates and their flanges to a depth of approximately one-fourthinch. The appliance now is complete and ready for use.

It has been found in practice that the instant device is superior to theformer practice of manually grasping the heel, placing an inversionstress on the ankle, and counterpressure on the tibia. When desired, fargreater stress can be placed on the ankle than with hands, due to theleverage obtainable through the crossbars and traction rope. The feltpadding 56 and the curves of the heel flanges 12, 14, and forefootflanges 16, 18, eliminate the problem of slippage. Any technician ofaverage intelligence can be taught to apply properly the instant devicethereby eliminating the need for the presence of the surgeon during thisprocedure.

In practice it has been found that with both the manual procedure andwith the use of the instant device, the degree of tilt is a directmeasure of the amount of underlying damage, with the occasionalexception of the case in which an injury has been superimposed upon apreviously hyper-mobile point. In no case in which there has beensuspected tear of the lateral ligaments has the instant device failed todemonstrate significant talar tilt. The criterion of fifteen degrees oftalar tilt is used as being indicative of tears sufliciently severe towarrant operative intervention or prolonged cast immobilization.

It has been found in practice that a stoic patient can tolerate stresswith no sedation or anesthesia. However, the placement of stress on anacute ankle injury is uncomfortable at best, so in order to eliminatethe question of personal spasm, and make the testing pain-free, theremay be employed a common peroneal nerve block with lidocaine at the neckof the fibula in routine testing of borderline injuries. Where it isobvious that a severe soft tissue injury has taken place, the femoralnerve is blocked justbelow the inguinal ligament, and the sciatic nerveis blocked in the buttock, and the ankle tested while preparations aremade for a primary suture.

It does not appear that testing under anesthesia introduces a tilt whichwould not have been present otherwise. Based upon operative attempts toextend incomplete tears by stress inversion, it does not appear thattesting under anesthesia will increase the severity of incomplete tears.

The instant device maintains stress positions of diagnosticsignificance. No talar tilt of significance is produced in a normaljoint either with or without anesthesia. In practice, it is desirable toobtain films of the contralateral joint in order to eliminate thequestion of bilateral hypermobility.

While the foregoing description and accompanying drawings are directedto a preferred illustrative embodiment of the appliance of the instantinvention and its manner of use, it will be understood that structuraldetails may be modified to suit the invention to particular specificadaptations without departing from the spirit of the invention, andthat, accordingly, it will be understood that it is intended and desiredto embrace within the scope of the invention such modifications andchanges as may be necessary or desirable to adapt it to varyingconditions and uses as defined by the scope of the appended claims.

I claim:

1. A surgical appliance for facilitating X-ray examinations of injuredankle joints, which comprises a rigid foot-piece including a pair ofcomplemental elongated laterally adjustable foot-strips adapted toextend longitudinally beneath a patients foot, each strip having aninner edge and and outer edge, an upstanding contoured heel flange oneach foot-strip along rear portions of each outer edge, an upstandingcontoured forefoot flange along forward portions of each outer edge ofeach foot-strip,

each heel flange being gently curved divergingly posteriorly and eachforefoot flange being curved inwardly with respect to its foot-strip,means enabling relative lateral adjustment of the foot-strips forenabling the flanges to engage snugly against the heel and forefoot,respectively, of a patients foot, the means for laterally adjusting thecomplemental foot-strips with respect to each other including a turretclamp secured to each strip in similar forward and rear locationsunderside each strip, a forward crossbar extending transversely withrespect to the complemental foot-strips through the forward turretclamps, a rear crossbar similarly extending through the rear turretclamps, the crossbars interconnecting the foot-strips forwardly andrearwardly thereof, the strips being slidable along the cross bars forsnugly interfitting the flanges on the foot-strips with the patientsfoot, and clamping set screws for each of the strips operativelydisposed in the turret clamps at right angles to the crossbars forreleasably securing the foot-strips in clamping position on the patientsfoot; a thigh band adapted to encircle the patients thigh, tractioncable means interconnecting the foot-piece and thigh band for impartingstress and tilt to the foot-piece and patients foot held thereby uponapplication of maximum inversion and moderate plantar flexion stressthereto through the 6 traction cable means, and means for securing thefootpiece and traction cable means in desired stress, and tilt forobtaining selectively both inversion and eversion stress roentgenogramsof an injured area.

2. A surgical appliance as claimed in claim 1, wherein each cross bar isprovided with clamping instrumentalities for flexible tensioning means,and flexible tensioning means releasably secured to the clampinginstrumentalities and to the thigh band for maintaining the foot-stripsand a patients foot clamped in the foot-strips in a selected position.

References Cited in the file of this patent UNITED STATES PATENTS620,582 Goff Mar. 7, 1899 2,520,248 Klaassen Aug. 29, 1950 2,545,510Bosler Mar. 20, 1951 2,696,208 Falls Dec. 7, 1954 FOREIGN PATENTS 7,337Great Britain Apr. 4, 1837 719,416 Great Britain Dec. 1, 1954 OTHERREFERENCES Hawley-Scanlan Catalog, received in Patent Oflice Mar. 24,1936. (Copy in Div. 55, pp. 10-11 relied on.)

